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General NPI Number Information
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NPI Number | 1013997410
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Entity Type | Individual
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Provider Name | MICHAEL T SHANDERSKY CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/20/2006
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 751 E BAYOU PINES DR SUITE L
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City | LAKE CHARLES
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State | LA
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Zip | 70601-7196
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Country | US
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Telephone | 337-436-8700
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Fax | 337-433-5942
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Provider Business Mailing Address
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Address Line | 4705 W QUAIL HOLLOW DR
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City | LAKE CHARLES
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State | LA
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Zip | 70605-5126
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Country | US
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Telephone | 337-478-8837
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 69234
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License Number State | LA
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